A 37-year-old male comes to the clinic with a complaint of a “sore on my penis” that has been there for 5 days. He says it burns and leaked a little fluid. He denies any other symptoms. Past medical history noncontributory.
SH: Bartender and he states he often “hooks up” with some of the patrons, both male and female after work. He does not always use condoms.
PE: WNL except for a lesion on the lateral side of the penis adjacent to the glans. The area is indurated with a small round raised lesion. The APRN orders laboratory tests, but feels the patient has syphilis.
Your Answer:
Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The disease progresses through four distinct stages if left untreated. Each stage is characterized by specific clinical manifestations. The four stages of syphilis are:
Primary syphilis is the initial stage of the infection and typically occurs around 3 weeks (10-90 days) after exposure to the bacteria. The primary feature of this stage is the appearance of a painless, round, and firm sore or ulcer called a chancre at the site of infection. The chancre is usually located on or near the genitals, including the penis in males. It can also occur in the vaginal or anal areas in females and males, respectively. The chancre contains a high concentration of the spirochete bacterium and is highly infectious. Without treatment, the chancre will heal on its own within a few weeks.
Secondary syphilis develops 4 to 10 weeks after the appearance of the chancre in the primary stage or sometimes overlapping with it. During this stage, the infection spreads throughout the body via the bloodstream, leading to a wide range of systemic symptoms. Common manifestations include skin rashes (often reddish-brown and non-itchy), fever, swollen lymph nodes, sore throat, headache, muscle aches, fatigue, and weight loss. The rash may involve the palms of the hands and soles of the feet. These symptoms may resolve spontaneously, even without treatment, but the infection persists.
Latent syphilis is a stage in which the infection remains dormant and asymptomatic after the secondary stage symptoms have resolved. There are two categories of latent syphilis: early latent (less than 1 year since primary and secondary stages) and late latent (more than 1 year since primary and secondary stages). During this stage, the bacteria are still present in the body but are not causing any noticeable symptoms. However, individuals with latent syphilis can still transmit the infection to others.
Tertiary syphilis is the most severe stage and can occur years to decades after the initial infection if left untreated. During this stage, the infection can affect various organs and systems in the body, leading to serious complications. Some possible manifestations of tertiary syphilis include neurosyphilis (involving the nervous system), cardiovascular syphilis (involving the heart and blood vessels), gummas (soft, non-cancerous growths), and potentially life-threatening complications.
It is essential to diagnose and treat syphilis early in the disease course to prevent the progression to later stages and to avoid severe complications.
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